Cancer is the second leading cause of human death next to coronary artery disease. Receptor tyrosine kinases (RTKs) play a key role in oncogenic transformation, growth and metastases. RTKs regulate cell differentiation, proliferation, migration, angiogenesis, and survival. The receptor tyrosine kinase-like orphan receptor 1 (ROR1) is an evolutionarily-conserved type I membrane protein that belongs to the ROR subfamily and has extracellular domains that contain immunoglobulin (Ig)-like, Frizzled, and Kringle domains. ROR1-deficient mice display a variety of phenotypic defects within the skeletal and urogenital systems, as well as postnatal growth retardation. ROR1 is expressed during embryogenesis and by a variety of different cancers, but not by normal post-partum tissues, and can be considered an onco-embryonic surface antigen. Functional data suggest that ROR1 may function in non-canonical WNT-signaling to promote the survival of malignant cells.
ROR1 expression and activation appears to be correlated with features of tumor aggressiveness in models of chronic lymphocytic leukemia (CLL), breast cancer, lung cancer, gastric cancer, and melanoma (Li et al., PLoS One 5(7):e11859 (2010); Gentile et al., Cancer Res. 71(8):3132-41 (2011); Zhang et al., PLoS One 7(3):e31127 (2012); Yamaguchi et al., Cancer Cell. 21(3):348-61 (2012); Daneshmanesh et al., Leukemia 26(6):1348-55 (2012); Daneshmanesh et al., Leuk Lymphoma 54(4):843-50 (2013); O'Connell et al., Cancer Discov. 3(12):1378-93 (2013); Hojjat-Farsangi et al., PLoS One 8(4):e61167 (2013); Hojjat-Farsangi et al., PLoS One 8(10):e78339 (2013); Ida et al., Cancer Sci. 107(2):155-61 (2016); and Janovska et al., Clin Cancer Res. 22(2):459-69 (2016)). Elevated levels of ROR1 expression in patients and cell lines are associated with genes involved in epithelial-mesenchymal transition (EMT) (Cui et al., Cancer Res. 73(12):3649-60 (2013)). In patients with CLL, high levels of ROR1 expression are associated with shorter treatment-free survival and overall survival (OS) (Cui et al., Blood 128(25):2931-2940 (2016)). Similarly, in patients with ovarian cancer, high ROR1 expression is associated with poor clinical outcomes (Zhang et al., Sci Rep. 4:5811 (2014)).
In view of the role of ROR1 in cancer, there is a need for new and improved therapies that target ROR1-positive cancer cells.